Report Clarifies Management of H. Pylori Gastritis

Eradication therapy should be first-line treatment, panel says

NEW YORK (Reuters Health) -- A new global consensus report aims to clarify the classification, diagnosis, and management of Helicobacter pylori gastritis.

"First of all, gastritis should not be used for the diagnosis of epigastric symptoms such as dyspepsia," lead author, Dr. Kentaro Sugano from Jichi Medical University in Japan, wrote in an email to Reuters Health. "It is an inflammatory disease of the stomach and hence its diagnosis should be based on pathologic findings of the mucosa."

H. pylori gastritis, the prevalent and most clinically relevant type of gastritis, was not integrated into the gastritis section of the current International Statistical Classification of Diseases and Related Health Problems (ICD-10).

Dr. Sugano and colleagues convened the Kyoto Global Consensus Meeting in order to classify chronic gastritis and duodenitis, to distinguish dyspepsia caused by H. pylori from functional dyspepsia, to define appropriate diagnostic assessment of gastritis, and to determine when and how to treat H. pylori gastritis, and in whom.

The researchers drafted 24 questions and asked expert panels to formulate relevant statements. The Delphi method, with a predefined level of 80%, was then used to develop the consensus.

Several questions addressed the appropriate classification of H. pylori gastritis, which the experts agreed should be separate from other forms of gastritis and should be categorized both by gastric sub-site and by histological and/or endoscopic severity.

Once H. pylori is identified as the cause of gastritis, eradication therapy should be the first-line treatment, according to the consensus statement published online July 17 in Gut.

The experts concluded that the best locally effective regimen should be used for eradication and treatment outcome should always be assessed. Patients whose symptoms persist after successful H. pylori eradication should then be considered to have functional dyspepsia.

The statement also says that while eradication of H. pylori reduces the risk of gastric cancer, it may not completely eliminate the risk. Therefore, patients who remain at risk should be offered endoscopic and histological surveillance.

"Physicians should be aware of the spectrum of gastritis with different gradients of gastric cancer risk," Dr. Sugano wrote. "They should be aware of the cutting-edge endoscopic diagnosis of gastritis."

"We hope that this consensus paper, together with the International Agency for Research on Cancer (IARC) statement, will encourage policy makers and doctors to promote eradication therapy for H. pylori gastritis to reduce gastric cancer," Dr. Sugano concluded.